The goal is to improve HIV patients' adherence to medication regimens. The investigators are planning an intervention in which the patient is given financial incentives to take clinic attendance seriously, and then given the option to make these incentives contingent on taking medications as prescribed—that is, to require better behavior from themselves to earn the same reward. Past studies have shown that conditional payments improve adherence to HIV treatment, but only while payments are being made. The investigators expect that patients will be willing to give up some payments to commit themselves to better adherence. The investigators also hope to see some patients maintaining good adherence after financial incentives are removed, among those who are given the opportunity to choose this commitment.

In the Incentive Choice arm, patients will first be presented with a brief explanation of the differences between the Attend-Check-up-Get-Paid arm and the Take-Meds-Get-Paid arm. The RC has a paper diagram that he will use in the explanation. Only after patients make a decision are they given a full walk-through of what they need to do to receive their incentive payment, as in the above Attendance Incentive arm. There is the question of how much detail we might want to shift from the walk-through to the initial brief explanation of the Attend-Check-up-Get-Paid arm and the Take-Meds-Get-Paid arm.

Other: Medication Adherence among HIV/AIDS Patients

If patients are interested and available, they will be scheduled for a first study visit ("study visit 1") involving enrollment and baseline data collection. The second ("study visit 2"), third ("3"), fourth ("4"), and fifth ("5") study visits will be used to implement the intervention with financial incentives and will involve data collection. The sixth ("6") will involve only data collection; there should be time during the sixth to complete chart extraction—for hospital, pharmacy, and clinical records.

Subjects will be told that study visit 5 is "the end of the study", although we "may follow up later". Study visit 6 will be an unanticipated meeting.

Experimental: Attendance Incentive Arm

In the Attendance Incentive arm, patients will be given a walk-through of what they need to do to receive their incentive payment, which would include attending their provider check-up, seeing the RC and remembering to bring their MEMs bottle.

Other: Medication Adherence among HIV/AIDS Patients

If patients are interested and available, they will be scheduled for a first study visit ("study visit 1") involving enrollment and baseline data collection. The second ("study visit 2"), third ("3"), fourth ("4"), and fifth ("5") study visits will be used to implement the intervention with financial incentives and will involve data collection. The sixth ("6") will involve only data collection; there should be time during the sixth to complete chart extraction—for hospital, pharmacy, and clinical records.

Subjects will be told that study visit 5 is "the end of the study", although we "may follow up later". Study visit 6 will be an unanticipated meeting.

Eligibility

Ages Eligible for Study:

18 Years and older (Adult, Senior)

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

The patient's most recent ART regimen has been in place for at least 24 weeks, counting back from the patient's most recently scheduled provider check-up.

Of viral load assays taken at least 24 weeks after the start of the patient's most recent ART regimen, the latest assay is higher than 400 copies/mL.

Patient is at least 18 years of age.

Patient collects his/her HIV medication only from the Ponce clinic.

Patient is not involved in another study.

Patient is not currently using a pill box or organizer.

Patient is not moving out of the area within the next 18 months.

Patient is not on the do-not-contact list.

Exclusion Criteria:

Patient is involved in another study.

Patient uses a pill box or organizer.

Patient is moving out of the area in the next 18 months.

Patient is on the do-not-contact list.

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.
To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.
For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01455740